Ovarian cancer

Question 1

Natural Hx of serous ovarian cancer

Answer 1

Epithelial ovarian ca are thought to develop from ectopic fallopian tube/ovarian surface epithelium
May have non-specific symptoms before dissemination occurs
>75% patients diagnosed at stage III/IV
Death from ovarian ca usually results from progressive encasement of abdominal organs –> anorexia, vomiting, inanition

Question 2

Risk factors of serous ovarian ca

Answer 2

BRCA1/2
no pregnancy
no breastfeeding
no OCP
no tubal ligation
nulliparity
infertility

Question 3

Prevention of ovarian ca

Answer 3

maybe removing fallopian tubes

genetic testing, removing ovaries/tubes if +ve

Question 4

Pre-cancerous stage of ovarian ca

Answer 4

Fallopian tube in situ

Question 5

Spread of ovarian ca

Answer 5

exfoliation of cells throughout abdomen
Dougla’s pouch (rectouterine), paracolic gutters, right hemi-diaphragm, liver, omentum
Lymph: periaortic, iliac, obturator, hypogastric

Question 6

SSx of ovarian ca

Answer 6

VAGUE until stage 3/4
Early: vague abdominal pain/bloating
symptoms of mass pressing on bladder/rectum
dyspareunia
menstrual irregularities

Advanced: abdominal pain/swelling
ascites
constipation
nausea
dyspepsia
anoexia/early satiety
irregular menses, heavy vaginal bleeding

Question 7

Dx of ovarian ca

Answer 7

Biopsy

Question 8

Staging of ovarian ca

Answer 8

surgical
I: confined to ovary
II: confined to pelvis
III:confined to abdomen
IV: distant disease

Question 9

Tx of ovarian ca

Answer 9

surgery + chemo

Question 10

Prognosis of ovarian ca

Answer 10

Poor if stage III/IV (symptomatic stages)
age>70
residual after surgery
poor chemo response

Question 11

Ovarian cancer oncogenesis

Answer 11

p53 gene alteration is the most frequent genetic aberration
Cyclin-dependent kinase inhibitors act as tumour suppressors by regulating transition between G1 –> S phase
p16 gene homozygous deletion in ~15%
Tumours from uterus, GI tract and breast = most common carcinomas to spread to ovary

Question 12

Ovarian tumour histology

Answer 12

3 sets of cells that give rise to tumours:
1) ovarian epithelium
- mimic development of Mullerian tract
2) Germ cells: mimic embryogenesis
3) Ovarian stroma: arise from primitive stem cells
-“female” cells = granulosa/thecal
“male” cells = sertoli, leydig

Question 13

Epidemiology of epithelial ovarian ca

Answer 13

8th most common in women
most lethal
majority are advanced stage, High grade serous cancer
incidence unchanged

Question 14

Familial ovarian cancer

Answer 14

serous epithelial
Autosomal dominant
- BRCA1/2
- Lynch syndrome: associated with non-serous epithelial tumours
Consider “prophylactic” oophorectomy in carriers
IN women in BC with high grade serous ca: almost 20% will carry BRCA mutation

Question 15

Benign germ cell tumor

Answer 15

cystic teratoma

Question 16

Functional ovarian tumours

Answer 16

All benign:
follicular cyst
lutein cyst
theca-lutein cyst
luteoma of pregnancy
endometrioma
PCOS

Question 17

Malignant germ cell tumours

Answer 17

dysgemimoma
immature teratoma
yolk sac tumour
embryonal
choriocarcinoma

Question 18

Sex cord stromal ovarian tumours

Answer 18

benign fibroma
Granulosa-theca cell tumours
Sertoli-Leydig cell tumour

Question 19

Serous epithelial ovarian tumours

Answer 19

75% of epithelial tumours
similar to fallopian tube epithelium
contain Psammoma bodies

Question 20

Mucinous epithelial ovarian tumours

Answer 20

20% of epithelial tumours
resemble endocervical epithelium
can get enormous